Impact of name-based implicit bias on time to diagnosis and outcomes in ST-elevation myocardial infarction

BACKGROUND: Patients with marginalised characteristics experience delayed ST-elevation myocardial infarction (STEMI) diagnosis despite fast-track protocols. We aimed to determine whether patients with phonetically uncommon surnames in our community experience delays from first medical contact (FMC) to STEMI diagnosis compared with patients with common surnames within an established fast-track network. METHODS: The Fast-Track Protocol for ST-Elevation Myocardial Infarction prospective registry enrolled consecutive STEMI patients from June 2008 to November 2024. Patient surnames were classified as phonetically common or uncommon using standardised phonetic matching against Canton Fribourg population data. Generalised linear models examined FMC-to-diagnosis time, FMC-to-balloon time and infarct size markers. Cox regression assessed major adverse cardiac and cerebrovascular events (MACE) at 30 days, 1 year and 5 years. RESULTS: Among 1208 patients, 284 (23.5%) had phonetically uncommon surnames. Patients with uncommon names experienced prolonged FMC-to-diagnosis time (59.4±87.6 vs 40.6±37.6 min; mean difference +16.8 min; p=0.009) and FMC-to-balloon time (116.8±90.5 vs 97.5±45.7 min; mean difference +17.5 min; p=0.016). Patients with uncommon names were significantly more likely to exceed the 90 min FMC-to-balloon threshold (39.2% vs 48.4%; p=0.010) and the 120 min threshold (16.4% vs 23.5%; p=0.018). Diagnosis-to-balloon time remained unaffected (p>0.80). Peak creatine kinase muscle-brain showed non-significant elevation (mean difference +52.0 U/L; p=0.077). No differences were observed in MACE at 30 days and 5 years between patients with common and uncommon names. CONCLUSIONS: Patients with phonetically uncommon surnames experienced significant STEMI diagnostic delays within an efficient fast-track network. Protocol-driven care following diagnosis operated equitably, leading to no difference in long-term MACE.